Job Description

Essential Job Duties:  

• Knows how to download Medicare claims in billing system daily or as needed.
• Monitors & processes credit balances for refunds and transfers in accordance with department procedures.
• Processes daily bills via Change Healthcare/Assurance, SSI and or Medicare DDE system if needed.
• Process claims and bills to payors through bill editor in accordance with department procedures.
• Knowledge in printing the Remittance Advices
• Works on denial accounts daily or as needed.
• Works on daily rejection daily or as needed.
• Works on daily mail and correspondence.

• Responsible for working off the work ques and clearing ticklers efficiently.

• Maintains quality control on all accounts for correct plan ID’s and financial class.  Updates system with appropriate changes.

• Sends requests to ancillary departments for reports needed to bill claims in a timely manner.

• Responsible to keep current with updates and changes within the Medicare via CMS website.

• Responsible to retrieve any patient information from the OneContent in Paragon for LA Market and or Power Chart in Cerner for Dallas and Chicago Facilities

• Processes daily contractual adjustments. & calculates payment and contractual adjustment according to expected reimbursement.
• Works and resolves aged accounts.
• Identifies under and over payments.
• Ensures each account has detailed documentation as required by the department procedures.
• Meets productivity requirements on a daily basis.
• Provides Medicare RA’s to cross over biller.
• Prepares credit balance reporting every quarter to Medicare.
• Demonstrates ability to reach decisions takes appropriate action and follow through within scope of responsibility, as defined by job description.
• Processes secondary billing and transfers in accordance with department procedures.

•  Additional duties and projects as assigned.

Behavioral Standards: 

• Exhibits customer and service oriented behaviors in every day work interactions.

• Demonstrates a courteous and respectful attitude to internal workforce and external customers.

• Communicates accurately and appropriately.

• Works well and efficiently under minimal supervision.

• Handles difficult situations in a discreet and professional manner.

• Is adaptable to changes in assignments and priorities.

Communication/Knowledge:

• Provides accurate and timely written and verbal communication of information in a manner that is understood by all.  

• Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.

• Able to use IT systems in an accurate and proficient manner.

Collaboration/Teamwork:

• Contributes toward effective, positive working relationships with internal and external colleagues.

• Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.

Education/Experience:

• High school graduate or equivalent required

• Prefer at least 2 to 3 years of current experience in an acute care hospital setting

• Computer skills preferred

Licensure/Certifications:

• N/A

ADA/Physical Demands:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.

• Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell.  The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.